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ORIGINALSTATE OF CALIFORNIA Do not fIu in THE RESOURCES AGENCY kii le with PWR DEPARTMENT OF WATER RESOURCES NO. 216097 Iof Intent No WATER WELL DRMLERS REPORT stat, Wel, No innt No or Date Other Well No Q 1) OWNER Name C d 2A 1111 11ML,agivi tC X r c r, (12) WELL LOG Total dee 1tl 5 f Depth of completed well-1-8-0—ft Address 2"Go P o iy e 1 1 St fmm ft to ft Formation (Descnbe by color character sue or irtaterial l tty _ Emeryville CA Zip 94508 0 - 10 Fine sand 2) LOCATION OF WELL (See instructions) 10 - 32 Slue clay County _ _ San_l o a Cil it owners V-ell Number P-6 A 32 - 4 8 Brown s i l t y c l a y ill address tf different fmm above O f f Sonora St , Stockton 48 - 1 2 5 Blue C 1 a� m riship 1 1'1 Range 6E Sectio 1 2 5 - 1 3 8 B l u e c l a y'� fS a n Dutamu from utieb roads narlruads fences etc 138 - 1 5 5 B 1 12.e'� c l a 165 - 185 Blue cj'ay c4(arse sand (3) TYPE OF WORK � New Well n Deepening ❑ ti See map attached Reconstruction ❑ Reconditioning ❑ _ - ' Horizontal Well ❑ `y♦ - ^ Destruction ❑ (Describe destruction matenals and j v procedures m Item 12,Y - 'i- (4) PROPOSED USS Domestic _ ❑ Imgation �� ♦ ❑ Industrial ❑ -- Test Well ❑ - Stock ♦ ❑< Municipal ) ❑ WELL LOCATION SKETCH Othen14 O n l t O r 2 n gC5 - i) EQUIPMENT (6) GRAVEL PACK - Rotary a Rei erre C Yes:fl: No ❑ Size - able C kir ❑ Diameter of bore ''Lt - ther C3 Bucket ❑ Packed fmm_�1 i_L_u�to. 1 8 0 -ft - (7) CASING INSTALLED (8) PERFORATIONS.. - Steel ❑ Plastid: Concrete [} Type of perforation,ar size of screen _From To Dia Gage or From - To Slot - ft ft m Wall ft ft size - 0 180 2t(` 42 40 170 ISO 20 - 1-7 (9) WELL SEAL 1 6 5 _ Was surface sanitary seal pmvided' Yes O-C No ❑ If yes to depth__ ft "ere strata sealed against pollution" Yes ❑ ho ❑ Intery _.._ft - - - Method of seahn 11 C—re t o b e n t o n i t e Work started 19 Complet -I9 (10) WATER LEVELS WELL DRILLER'S STATEMENT tpth of first water rf know �� 7,,6iriuell Was 1 under my iuriydictio this rt it true to the ben of my 'tandmrC level after well completi 'kna&redge a of (11) WELL TESTS SlcNsii Was well test made' Yes [ No [�Mf yes by whom?' r I - (Well Dnlle �ype of test Pump (] Bader © -.� Air _ " t� NkW - I a m O n f,O D r i l l r I n C epth to water at start of test ft At Fria of t R -4 f (Person. firm or corporation) (Typed or printed) rge eat/roan after hours Wates eir{�ea - 4dd 7� Citi, .2 d r o , C'A zi &,L::�In. lanalysis made? Yes ❑ No 9 If yes by whor`e` -'-- Palo p`�73 It., made? Yea 0 No ['# If ves, attach copXKo� rep�'t�.7 rss T,a enae No. 5 1 2 4 0 6 - _Date of this repo t?WR 188 (REV 7 76) IF ADDITIONAL SPACE 15 N EXCONSECUTIVELY NUMBERED FORM �,jS